Gleason score 3 +4; Does percent of 3 versus percent of 4 matter?

@pblanch
This reinforcement is even more That you really want to consider active surveillance and no treatment at this point.

See what the decipher score shows it’s probably going to be low.

@jeffmarc Thanks Jeff

@pblanch

As Jeff and others indicate:

At 79, Active Surveillence with 1 core of 3+4 makes sense.

I have not had treatment yet. For the past 9 months, been working on obtaining information.

-PSA
-4K Blood test may make sense. Cheap and easy blood draw.
-Any lesions seen on MRI?
-MRI indicate any possible extracapular extension? ECE /EPE?
-PSMA PET scan performed?
-Do you have historical PSA test results? Has PSA been gradually going up or recent spike.
-“I think” A lot of what you want to determine is: How likely is the cancer to metastasize outside the prostate in the next few years?
-Ask your medical team, why treatment would be better than Active Surveillence. And, what tests can be performed or information obtained to better make a decision to not stay on Active Surveillence.

Best Wishes.

@charlesprestridge Thank you for all the information; I’ll be asking my urologist these questions 🙂

@jeffmarc just the one 3+4 core from the legion that shoes up on the MRI; the 11 other cores were called ‘benign,’

Yes...As a post-prostatectomy patient, I too was/am a Gleason 3+4 with only 6-10% of cells being "4". In other words, it was caught early (or so I thought). I had 3 cores negative, three cores 3 + 3 = 6, and six cores 3 + 4 = 7, again, with just 6-10% of cells being type "4". But that can fool you (read last paragraph).
If your physician did not share this with you, the process is that the pathologist scans all 12 microscope slides in their entirety from your 12 core biopsies. They scan the slide once and determine what cell type/level/grade is predominate. That is the first number in your Gleason Score. In your case and mine, it was "3" which is fortunately a low to low-moderate level. The pathologist then scans the slides a second time and looks for the next-most predominant cell type. In your case and mine, it was "4" level cells. They will do as was reported to you: they give you the percentage of the second most predominate cell type so you can compare it to the most predominant cell type by simple subtraction: 100% - 10% type or level "4" = 90% type or level "3" cells.
So this is the last paragraph mentioned above: I have often written here that the Gleason Score is only the "tip of the iceberg", with a whole heck of a lot of underlying pathology that the Gleason Score can't ever reveal until your prostate is removed and a pathologist microscopically examines the entire tumorous areas of the prostate - not just 12 tiny cores. I am a living example of that: After the biopsy and Gleason Score revealed a 3 + 4 = 7 my physician confidently said "we caught it early!" Then I had the prostatectomy that included removal of both seminal vesicles and both vas deferens. The surgical pathology report of the entire prostate was much more ominous. I had Extraprostatic Extension ("EPE"); "Surgical Margins" (one of the unlucky 10% that had cancerous tissue left in my body with the only hope that the cells will die without blood supply before they migrate to find it); I had left seminal vesicle invasion (no tumors or nodules...just cells, but still a bad sign); And finally, what was initially reported as Cribriform Glands, that was later retracted when I asked for a review of the slides to tell me what "type" (of many) my Cribriform tissue was. None of this could have been revealed by the 12 small core biopsy samples. It would only be luck if any of it was seen on biopsy. So...my physician was quite humbled when he got my pathology report. He said: "It seems that your cancer is much more aggressive than I would have thought," as he expressed his thankful decision to push for the prostatectomy. I too was thankful. Good luck on your new life's journey.

Thank you rlpostrp for your sobering account; I am sorry about your fate. Several questions come to mind…What was your age when you had the original biopsy, when you had your prostate removed, and how old are you now? I ask because I’m 79 so if my condition is not very aggressive (which based on your experience is a gamble) it’s a race to the finish line to see if it’s prostate cancer or something else that kills me…my father lived with pc for 20 years and died at 97. Another question: did your biopsy samples have Decipher analysis? Thank you for the sobering information; I appreciate it.